Species Composition and Susceptibility to Antibiotics of Microorganisms Isolated from Tooth Sockets of Extracted Teeth in Cases of Alveolar Osteitis

Alveolar osteitis (AO) is one of the most common infectious complications after dental extractions. The data on the species composition of AO pathogens and their susceptibility to antimicrobial drugs can be the basis for their empirical use in case of inflammatory process aggravation. Objective. To determine the species composition and susceptibility to the antimicrobial agents of microorganisms, which were detected in patients with AO, who sought medical help in the oral surgery department of the dental medical center of Bogomolets National Medical University. Methods. Throughout 2018–2021, microbiological examination of tooth sockets from 30 patients with AO and 20 patients without AO was performed. The studied biological material was plated on appropriate nutrient media for isolation of aerobic, facultative and obligate-anaerobic microorganisms. Anaerobic conditions were achieved in GENbox 7.0 L and GENbox 2.5 L aerostats using GENbox anaerobic packages (“Biomerieux”, France). The genus and species identity of the bacteria were determined according to Bergey. Antibiotic susceptibility of the isolated strains was determined by disk diffusion method. Results. It was found that most commonly microorganisms from tooth sockets in case of AO are: Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus spp., Escherichia coli, Bacteroides spp., Clostridium spp., and Candida species, as well as their mixed cultures of 3–5 species of microorganisms. These aerobic and facultative anaerobic bacteria were susceptible to amoxicillin, ceftriaxone and ciprofloxacin in 92.6–100% of cases. The growth of anaerobic bacteria in 100% of cases was inhibited by colistin and meropenem. Conclusions. AO developing is caused by pathological colonization of socket of the extracted tooth by representatives of endogenous microbiota, namely Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus spp., Escherichia coli, which are present mainly in the mixed cultures with Candida albicans. For empirical antibiotic therapy of complicated forms of AO, amoxicillin or ceftriaxone or ciprofloxacin in complex with colistin or meropenem should be used, since these drugs suppress the growth of 92.6–100% of strains of aerobic, facultative and obligate anaerobic microorganisms, which are potential pathogens of the purulent forms of AO.

Clinical Audit of Two Standard Surgical Site Treatments Following Dental Extractions and The Impact on Incidence of Alveolar Osteitis Within a Specialist Dental Clinic

Background Alveolar osteitis is a painful condition following dental extraction associated with absence of blood clot and consequent exposure of underlying alveolar bone. It is a condition whose exact aetiology is unresolved and a known complication in up to 30-40% of dental extractions. The following report details a retrospective evaluation of two approved, long-standing wound care treatments used, post-extraction, within our clinic to assess for relationship with alveolar osteitis incidence. Methods Patients undergoing non-acute dental extraction at a dental out-patient clinic in the UK had received two different standard treatments for a period from 2000 to 2014. The treatments were mouth rinse with physiologic saline or surgical site irrigation and mouth rinse with physiologic saline-low dose aqueous chlorine used in wound and burn-site care. Retrospective, post-operative outcome analysis suggested improved outcomes with one of the standard treatments versus the other. A full retrospective audit of consecutive treatment outcomes was implemented to test the hypothesis. The audit data-collection was blinded to the treatment administered and to the identity of the treating clinician. Statistical analysis was carried out independently and blinded to the treatment modality. Results All patients were routinely reviewed within seven days and a determination of un-complicated healing vs alveolar osteitis (requiring further intervention) was made. Our results show that treatment with of aqueous chlorine in physiological saline significantly reduced the incidence of alveolar osteitis versus the control group who received physiologic saline without socket irrigation and chlorhexidine oral rinse home-care. (Odds Ratio 0.0146 Relative Risk 0.029 (95%CI 0.0093 to 0.0928) significance (p<0.001). Conclusions This is the first report to show an extremely significant reduction in the incidence of alveolar osteitis following treatment with low dose aqueous chlorine in physiological saline compared with those receiving the physiologic saline and saline mouth rinse or Corsodyl mouth rinse. This shows an approach to surgical site care is superior to the most common, reported, standard of care treatment. The impact of this has led to improved antibiotic stewardship within the clinic for dental extraction or elective oral surgery, including third molars.

Comparison of Alveolar Osteitis (AO) occurrence after impacted mandibular third molar removal with and without post-extraction socket irrigation

Objective: We wanted to see whether impacted third mandibular molar extractions resulted in Alveolar Osteitis if post-extraction socket irrigation was used or not. Methodology: A randomized control experiment on 70 patients study was conducted from July 2019 to January 2020 at Islamabad Dental Hospital's OMFS department. Patients presenting with the mandibular third molars fulfilling the inclusion criteria had their teeth extracted with and without socket irrigation using the computer lottery method. In cases of dry socket, clinical diagnosis was made between the 3rd, 5th, and 7th postoperative days. Results: 70 patients/sockets were evaluated with 35 having been irrigated and 35 non-irrigated. The age range was 16-50years with a mean of 29.49 and most patients were between the 16-35 age group. There were 48.6% males and 51.4% females. Dry Socket was evaluated on the 3rd, 5th, and 7th day between groups (A=irrigation, B=Non-irrigation). On the 3rd postop day, 14 (40%) patients in group A and 15(42.9%) patients were diagnosed as dry Sockets. A similar number of patients in both groups (20%) exhibited symptoms of dry socket on the fifth and seventh postoperative days, as did 5 (14.3 %) in group A, 3 (8.6 %) in group B, and 1(2.9 %t) in group A, all on the fifth postoperative day. Conclusion: On the third, fifth, and seventh postoperative days, there was no significant difference in the result of Alveolar Osteitis between the groups.

Risk factors of complications subsequent third molar extractions: A prospective cohort study

Objective: The aim of this study was to determine the complications that were associated with the surgical removal of third molars (M3s), and to assess the association of patient, anatomic, and surgical risk factors with the postoperative complications of surgically removed impacted M3s. Material and Methods: This study was a cohort prospective study conducted on patients, aged 17 and older, admitted to the oral and maxillofacial surgery clinic. All patients who needed 1 or more extractions were included and totalled 268 patients with 314 extracted teeth. Risk factors were divided into patient factors, anatomic factors and surgical factors. The postoperative complication variables mainly included: pain, alveolar osteitis, infection, bleeding, swelling, trismus. Statistical analysis used: Chi-square test was used for the bivariate analyses while Pearson correlation coefficient (1- tailed) test was used for the purpose of determining the association between the study variables. The significance of associations was considered statistically significant at P < 0.05. Results: Patients aged of 25 years and above experienced more complications, 39 (88.6%). With respect to gender, females experienced more complications, 29 (65.9%). Mandibular M3s had more complications than maxillary M3s, 34 (8.0%), followed by distoangular inclined M3s, 23 (52.3%), and last was full bony impaction, 13 (29.5%). Pain was the most frequent complication, 18 (40.9%), followed by alveolar osteitis 12 (27.3%). Conclusion: The results indicated that the most frequently complications were pain, infection, alveolar osteitis. These complications were associated with common risk factors such as age, gender, medical history, M3 angulation, impaction level, bone removal, tooth sectioning, and number of M3 removed per session. Keywords Complications; Surgical extraction; Third molar.

Iatrogenic fracture of right angle and left sub condyle in a 50 year old male: A case report

Iatrogenic errors during exodontias includes trismus, alveolar osteitis, postoperative infection, hemorrhage, oro-antral communication, damage to adjacent teeth, displaced teeth, and fractures.While doing extraction chances of occurrence of fracture of mandible is fortuitously rare, but is under-reported. These fractures could occur in the intra-operative or postoperative period and can cause significant distress to the patient and the practitioner. This case report addresses the incidence of mandibular fracture in a 50-year-old male and various surgical treatment modalities and ways of prevention are discussed.

Lingual split bone technique – Revisited as a standard operating procedure for surgical removal of third molar during COVID pandemic

Objectives: The objective of the study is to revisit the forgotten art of Lingual split bone technique during the COVID pandemic as a Standard Operating Procedure (SOP) for the surgical removal of impacted mandibular third molars. It was originally introduced in early 90’s by Sir William Kelsey Fry and also we have compared its advantages over the bone guttering technique. Materials and Methods: Twenty seven cases were operated during COVID pandemic in our institution using Davi’s modified lingual split technique under strict COVID protocol. Results: All impacted mandibular third molars were successfully removed. With regards to post-operative complication; 3 patients had nerve injury (11%), 2 patients had lingual paraesthesia (7.6%), 1 patient had alveolar osteitis (3.8%), 2 patients had postoperative infection (7.6%), 3 patients had trismus (19%). The overall success rate was 100%. Also the results of a comparison between bone guttering and chisel-mallet technique were stated. Conclusion: The use of lingual split bone technique deserves consideration during this COVID time as an alternate for bone guttering in surgical removal of third molar as it ensures minimal cross infectivity rate among both dentists and patients. Thus, patient care can be delivered with confidence even during pandemic.